AcuteCare Telemedicine Blog


Telemedicine Increases tPA Use for Stroke Treatment

Presented at the annual American Academy of Neurology meeting in early May, a new study highlights the benefit of teleneurology care. The report indicates that a telemedicine program for patients with acute ischemic stroke increases the use of recombinant tissue plasminogen activator by as much as 13% in the year after the program’s implementation.

Stroke patients who receive the clot-busting drug tPA within 60 minutes of experiencing stroke symptoms have the best chance of avoiding brain damage or death. The administration of intravenous recombinant tissue-type plasminogen activator (tPA) and intra-arterial approaches, attempt to establish revascularization so that cells in the penumbra can be rescued before irreversible injury occurs, but restoring blood flow can mitigate the effects of ischemia only if performed quickly. “Most of the 13 hospitals in the study significantly increased their recombinant tissue plasminogen activator (tPA) use”, Dr. Jeffrey C. Wagner said at the annual meeting of the American Academy of Neurology.

The study population included patients aged 18 years and older who were admitted with a primary diagnosis of acute ischemic stroke. The hospitals represented a variety of patient demographics. About two-thirds were rural; approximately half were small, defined as fewer than 200 beds. The hospitals were located in the Northeastern, Southern, and Western portions of the United States.

Overall, tPA administration increased significantly, from 4.5% to 7.3% after a telemedicine program was introduced and the use of tPA in smaller hospitals increased from 1% to 7% after implementing a telemedicine program, compared with an increase from 5.4% to 7% in larger hospitals. Those results were similar when patients were stratified as inpatients or transferred patients.

The benefits of intravenous tissue plasminogen activator (tPA) in patients with acute ischemic stroke (AIS) are time dependent and guidelines recommend a door-to-needle (DTN) time of 60 minutes or less. However, studies have found that less than 30% of US patients are treated within this time window. Target: Stroke was designed as a national quality improvement initiative to improve DTN times for tPA administration in patients with AIS. Implementation of a national quality improvement initiative was associated with improved timeliness of tPA administration following AIS on a national scale, and this improvement was associated with lower in-hospital mortality and intracranial hemorrhage, along with an increase in the percentage of patients discharged home.

“Reducing DTN time is a primary goal when treating patients via telemedicine”, says Keith A. Sanders, Founder and Director of the Stroke Center of Emory St. Joseph’s Hospital and AcuteCare Telemedicine (ACT) COO. “ACT has seen dramatic improvements in the tPA administration rate and DTN times at our hospitals. We collect, review and distribute DTN times and other quality measures to our hospital partners. This report reaffirms the importance in administering tPA and its impact on patient outcomes.”


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